Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-18-32463 |
NPI | 1003388356 |
---|---|
Provider Name | Daniel Alexander Palm |
First Address | Rocklin, CA 95677-2995 |
Second Address | Rocklin, CA 95677-2995 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2018 |
Last Update Date | 27/12/2018 |